Thumb sucking
| Classification according to ICD-10 | |
|---|---|
| F98.8 | Other specified behavioral and emotional disorders beginning in childhood and adolescence |
| ICD-10 online (WHO version 2019) | |
Thumb sucking is a habit of humans and other primates to put the thumb in their mouth and suck or suckle on it.
Origin and occurrence
Proportion of "lollipops" per age group, according to two different studies |
People are born with a sucking reflex , which triggers sucking mouth movements when the lips or the tip of the tongue are touched and which ensures the supply of food in the first year of life. This reflex has also been observed in monkeys. Fetuses trigger this reflex themselves in the womb by putting their thumbs in their mouths; this suggests that the reflex itself conveys pleasant sensations. However, since it is no longer detectable after the first year of life, this alone cannot explain the thumb sucking.
In contrast to highly developed civilizations, thumb sucking apparently rarely occurs among primitive peoples and peoples who cling to ancient breastfeeding habits. The infant receives the breast as soon as it cries. It has therefore been suggested that thumb sucking is a substitute for this consolation.
Psychologists suspect that children associate suckling with peace, security and beneficial food intake. They later used this knowledge by putting objects in their mouths and sucking on them in order to relax in stressful situations. The assumption is supported by the observation that the more excited they are, the more intensely and quickly the children suck. The subject is interchangeable; In addition to thumbs or other fingers, pacifiers , comfort blankets or items of clothing can also be considered.
Depth psychologists suggest that thumb sucking imparts sexual pleasure and is a form of masturbation for children.
Many small (3 or 4 year old) children have not yet developed a sense of shame about their sucking activity and react with pride when asked without a censure undertone. Sometimes when sucking their thumbs, they do sideline activities such as stroking their ears and nose or twirling their hair.
The frequency of thumb sucking in children depends on age (see table). In some studies it was given across the board as 54% of all children and 61% of all 6 to 14 year olds.
consequences
According to medical doctrine, thumb sucking is harmless up to the age of three and should not be suppressed. Anything that goes beyond this is seen by specialists as a bad habit (habit, parafunction ) that can have physical consequences.
Thumb sucking is one of the habits that play a major role in the faulty development of the jaw ( dysgnathia ). Since the thumb pushes the upper incisors forward during their growth phase, the teeth can become inclined. In particular, a relationship between thumb sucking and protruding upper incisors , enlarged overjet and a frontal open bite can be demonstrated . The effect on the steepness of the lower incisors and the position of the lower jaw is not statistically significant. The extent of the change arguably depends on the intensity of the habit. Some doctors believe that the restricted freedom of movement of the tongue leads to initial difficulties in articulation and, consequently, to delayed language acquisition.
Damage caused by thumb sucking during the first three years of life is generally harmless, as it regresses without any external influence. Under normal hygienic conditions, it is also considered harmless that pathogens get into the mouth when sucking the thumb.
Excessive thumb sucking, or thumb sucking well beyond the common age, can be a behavioral disorder that requires psychological treatment. It is diagnosed with the ICD code F98.8.
Weaning
As a learned behavior, thumb sucking can also be stopped again. Punishing the child for doing this or putting bad-tasting tinctures on their thumbs can be effective, but educators do not approve of it.
Rather, the child should be brought to the point where they perceive not sucking their thumbs as an independent decision. For example, it is recommended that children first get used to a pacifier by repeatedly offering them and then after a reasonable period of time to dispose of it in a ritual without replacement.
Many children get used to sucking their thumbs if they are teased for it by other children.
Medical history
Thumb sucking was neglected in medical literature until the late 19th century. It was first mentioned as harmful in the specialist literature in the late 1870s, and by 1910 had become a permanent fixture in textbooks on childhood diseases. Even in the late 19th century, thumb sucking was often considered a harmless pleasure for the child, but in the medical context it was considered serious, pathological behavior. Ultimately, it was classified as a nervous disease that could only be understood by expert pediatricians.
Childish thumb sucking was first mentioned as harmful behavior in an article by US doctor Thomas Chandler in 1878. Chandler saw it as a major cause of jaw deformities and irregular teeth, along with heredity. Furthermore, deformations of the hands and a weak-minded expression are to be expected.
"Many are absolutely incurable and the victim may be compelled to carry the marks of this practice and their accompanying discomforts through a long life."
"Many are completely incurable, and the victim can be forced to bear the marks of this practice and the associated ailments for a long life."
The German pediatrician S. Lindner pointed out in 1879 that Chandler had not recognized the full scope of the problem and dealt in detail with the problem of sucking on the fingers, lips and other parts of the body (called by him "Ludeln" ) apart. He attributed it to an innate tendency in children to bring everything to their lips. He cited mental decline, scoliosis , crooked mouth, misaligned teeth, misshapen jaws and - as a sexual element - masturbation as possible consequences . Lindner emphasized that thumb suckers could increase their pleasure through “active support”, i.e. by simultaneously touching certain points on the head, neck, chest, stomach or pelvis (here, the genitals ).
In 1895, Samuel Hopkins also took Chandler's statements and continued them in a monograph on the subject, warning of dangerous effects on intellectual and moral development.
"So hideous is the deformity caused by this habit, that it seems incredible that it should be necessary even to call attention to it, much less to urge that action be taken to put a stop to the evil."
"The deformity caused by this behavior is so abhorrent that it seems unbelievable even to have to draw attention to it, even to urge action to be taken to combat the evil."
Lindner was quoted, among other things, in the first textbook on pediatrics, which treated thumb sucking as a separate topic. Its author Luther Emmett Holt classified it under the section "Nervous diseases" and saw the habit of masturbation as "probably the most harmful effect" of thumb sucking. Even Sigmund Freud quoted Lindner in his Three Essays on the Theory of Sexuality (1905), where he thumb-sucking as an example of filial Autoerotics mentioned.
Subsequently, thumb sucking has been described as a masturbation-related disease that requires the same treatment modalities. Karl Goldstone, for example, listed early prevention as well as gentle admonition and hygiene as countermeasures for both practices in 1908. Charles Kerley recommended in 1914 to avoid scratching, thumb sucking, nose picking, masturbation and pulling on ears and lips a device called "Hand-I-Hold Mit", which was placed over the hand and prevented any contact with fingers.
Since thumb sucking was a very common activity, it could not be classified as pathological over time. As a result, various paediatricians considered it a "bad habit". Until the middle of the 20th century, an entry on thumb sucking was common in specialist books on childhood diseases.
Gillis suspects that the paediatricians classified relatively harmless behavior such as thumb sucking as an illness in order to be able to produce a justification for their profession as an independent medical branch. Since parents and doctors often had nothing against child's thumb sucking, contrary to medical knowledge, and nurses welcomed it as a means of calming the child, paediatricians could have established themselves as the only competent authority.
media
In Heinrich Hoffmann's Struwwelpeter (1845) the "thumb sucker" Konrad is punished by cutting off both thumbs.
Walter Kirn's 1999 novel Thumbsucker and a film based on it also deal with the subject .
literature
- Jonathan Gillis: Bad Habits and Pernicious Results: Thumb Sucking and the Discipline of late-nineteenth-century Paediatrics. In: Medical History. No. 40, 1996, pp. 55-73, ISSN 0025-7273
swell
- ↑ a b c A. Kantorowicz : The importance of sucking for the development of acquired malformations. In: Advances in Orthodontics. Vol. 16, No. 2, 1955, pp. 109-121.
- ^ A b Erwin Reichenbach, Hans Brückl: Orthodontic Clinic and Therapy. J. A. Barth, Leipzig 1962
- ↑ T. Rakosi, in German Stomatology. Vol. 14, 1964, p. 211.
- ↑ D. Neumann, quoted in Reichenbach / Brückl
- ↑ PM Schopf: The Influence of Habitual Factors on Adolescent Dentition. In: Advances in Orthodontics. No. 34, 1973, pp. 408-432.
- ^ TH Chandler: Thumb-sucking in childhood as a cause of subsequent irregularity of the teeth . In: Boston Medical Surgery Journal . No. 99 , 1878, pp. 204-208 . Quoted from Gillis.
- ^ S. Lindner: Sucking on the fingers, lips, etc. with the children (Ludeln) . In: Yearbook for Pediatrics . No. 14 . BG Teubner, Leipzig 1879, p. 68-91 .
- ↑ Samuel Hopkins: The habit of thumb sucking . John Wilson, Cambridge 1895, p. 7 . Quoted from Gillis.
- ^ Luther Emmett Holt: The diseases of infancy and childhood . Appleton, New York 1897, pp. 695 . Quoted from Gillis.
- ^ Karl Goldstone: The injurious habits and practices of childhood: their detection and correction . In: Med. Rec. 1908, p. 1030-1033 .
- ^ Charles Kerley: The practice of pediatrics . W. B. Saunders, Philadelphia 1914, p. 468 .